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HomeMy WebLinkAboutFreeform Building Partners ELIZABETH A. NEV~.I,~, TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER :, _!~) ' ' OFFICE OF THE TOWN CLERK J~"L s~p - 6 2~ i'5j TOWN OF SOUTHOLD 0 : 'S6iJt[t~ld TownjBuilding Department FROM: Linda J. Cooper, Southold Town Clerk's Office Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 southoldtown.northf0rk.net DATED: Transmitted herewith is a copy of application No. 3506 for a Cesspool/Septic Tank Construction Permit submitted by: FreeForm Building Partners LIc. Please review the application and location map and advise if the project has received Suffolk County Health Department approval and if this office may issue the permit. Please complete the form below and return it to me. Linda J. Cooper I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE Comments: DISAPPROVE Signature OFFICE OF THE TOWN CLERK Town of Southold Judith T. Terry, Town Clerk Town Hall, 53095 Main Road P. O. Box 1179 Southold, New York 11971 Telephone (516} 765-1801 TOWN OF SOUTHOLD Application No. Construction Alteration $10.00 - Residential $25.00 - Non-Residential 5OUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION · for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No.~ DATE APPLICANT ADDRESS: ~1~'~ ~,~ ~ ~,1~___.. DESCRIPTION OF P~OP~SED CONSTRUCTION OR ALTERATION J LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: OWNER MAILING ADDRESS: OWNER PROPERTY ADDRESS: TELEPHONE NUMBER OF CONTACT PERSON: TAX MAP NO.: Section II~OD Block cross STREET: BUILDING PERMIT NUMBER CROSS REFERENCE: RECEIVED BY: DATE: Town Clerk's Office 'LOT° AREA = 83.771 SQ. FT. F FL ELEV , 28.0 C-AR' ELEV 26.0 LOT ~IUN~ 4, - 8T41'2g''rc (~.0) NOTE LOT CLEARfNG SHALL BE LIMITED TO 1 ACRE 298.36' EECEIVED SUFFOLK (24,.6) R=85.00' L--71.75' 15.08' ~T- 7/7/df ~I. RE,. Ho. /~/~ -'~ --o/~ ~ FOR MJ~I#u# OF ~ BZDROOliS EXPIRES THREE YEARS FROM DATE OF' APPROVAL (~.o) N 73'05'20'1// $05.61' 'NORTH BAYVIE ROAD 6 - 20 - 2005 REVtSE SANITARY SYSTEM 12-10-2004 RE'VlSI SANITARY LOT N~ 5 ~ OF Z~ ~N~ C~P. ~ 1' = ~' ~ 10-1~--~ ONLY TO: HAROLD F. TRA.NCHON JR. PENN. MC. Ne. 211~-E TAX ~ No.(RI:I~ 0NL~ 10OO-79--4,-P/O 17.17 HAROLD F, T~N JR. P.C. P.O. ~X 6~ ~B WA~ ~"ER-~ ~. WA~ ~ER, 83